Losing Employer-Provided Health Insurance - Ohio Department of ...

Losing Employer-Provided Health Insurance
How to find health coverage for you and your family
Facing the loss of health insurance is unsettling and the transition phase into new coverage can be
stressful. The Ohio Department of Insurance has prepared this document to help you understand
the different health insurance coverage options available in Ohio for you and your family.
Call the Ohio Department of Insurance at 1-800-686-1526 to talk with a Consumer Services
representative about your health insurance options. You can also visit www.insurance.ohio.gov
— the Department’s web site — for more information.
Special Enrollment in Another Group Plan
If other group health coverage is available such as through a spouse’s employer provided plan,
special enrollment in that plan should be considered. It allows the individual and his/her family
an opportunity to enroll in a plan for which they are otherwise eligible, regardless of enrollment
periods. However, to qualify, enrollment must be requested within 30 days of losing eligibility for
other coverage. After special enrollment is requested, coverage is required to be made effective no
later than the first day of the first month following your request for enrollment. This type of coverage
is usually the most cost-effective of all the options.
COBRA coverage
Ask if you are eligible for your employer’s Consolidated Omnibus Budget Reconciliation Act
(COBRA) coverage. You have the right to continuation of individual and family health insurance
coverage if you lose your job.
• If you have pre-existing health conditions and are eligible, you cannot be turned down or
charged more due to your health conditions.
• COBRA is a federal law providing for continuation of coverage for former employees of
companies with 20 or more employees. COBRA lets you continue the same policy, in some
cases up to 36 months.
• Employers should send you a COBRA notice. You then have 60 days to elect the coverage.
• For workers who were involuntarily terminated between Sept. 1, 2008, and Dec. 31, 2009, the
federal government will subsidize 65% of their premiums under COBRA for up to 9 months
beginning March 2009.
• To receive the subsidy, participants must attest that their same-year income will not exceed
$125,000 for individuals and $250,000 for families.
• Visit www.insurance.ohio.gov/ConsumServ/COBRA.htm.
Mini-COBRA coverage
Ohio law provides those who were employed by small companies with 2 to 19 employees have the
right to continue coverage under a group plan for up to 12 months. Employers should send you a
state continuation coverage (mini-COBRA) notice.
Continued on page 2
Governor John. R. Kasich
www.insurance.ohio.gov
Lt. Governor/Director Mary Taylor

Losing Employer-Provided Health Insurance Page 2
• For workers who were involuntarily terminated between Sept. 1, 2008, and Dec. 31, 2009 and
who are eligible for state continuation coverage, the federal government will subsidize 65% of
their premiums for up to 9 months beginning March 2009.
• To receive the subsidy, participants must attest that their same-year income will not exceed
$125,000 for individuals and $250,000 for families.
• Visit www.insurance.ohio.gov/ConsumServ/COBRA.htm.
HIPAA coverage
If you are not eligible for COBRA or when COBRA expires, but you have had 18 months of
continuous group health coverage where the most recent coverage was under an employer
group health plan, you are considered “Federally Eligible” for a Health Insurance Portability and
Accountability Act (HIPAA) plan. The 18 months could be a combination of any creditable health
coverage, including Medicare. You need to apply for either the “Ohio basic” or “Ohio standard”
health plan within 63 days of losing your previous coverage.
Individual coverage
Individual means the insurance is not connected to an employer plan. Individual plans are
medically underwritten. Companies can decline you based on your health or attach exclusions to
your policy. Individual plans take into account your past and present health and then factor it into
your premium. Costs vary so shop around and also consider working with an insurance agent.
Open enrollment
If you are unable to secure coverage through the normal enrollment process, you may be able
to get coverage through open enrollment, which is conducted on a first-come, first-served basis.
Applicants are accepted until each Health Maintenance Organization (HMO) and traditional insurer
reaches a statutory quota. Coverage secured during open enrollment can be expensive and it
must take effect within 90 days after the company accepts your application. However, the policy
may require you to wait one year before preexisting conditions are covered.
High-deductible major medical policy
When it comes to insurance, no matter the type, higher deductibles usually mean lower premiums.
That is because you are taking more responsibility for your own care. You may be able to combine
a Major Medical plan with a Health Savings Account, which basically allows you to spend pre-tax
money on your smaller health bills and use the Major Medical plan for the catastrophic expenses.
Short-term insurance
While this won’t cover pre-existing conditions, it is better than no coverage at all. You can generally
take these out either on a month-to-month basis or on a term of six to 12 months. Even though this
doesn’t cover pre-existing conditions, it may cover unexpected or acute conditions, for example, a
broken leg.
Continued on page 3
Governor John R. Kasich
www.ohioinsurance.gov
Lt. Governor/Director Mary Taylor

Losing Employer-Provided Health Insurance Page 3
Discount health plans
These plans are not insurance products; instead, they discount services provided by certain
physicians, hospitals and pharmacies. If insurance is unaffordable to you, a discount health
plan may serve as an option to lower your costs in certain situations. Be certain to read the
membership agreement. The Department has limited authority over these plans.
Professional organizations and association plans
Sometimes local associations such as chambers of commerce and professional groups
offer health insurance. Coverage may also be available through a religious or fraternal
organization.
Veteran benefits
If you are a veteran, the Ohio Department of Veterans Services at 1-877-644-6838 can
outline assistance that may be available to you, such as TRICARE.
Free Clinics
Free clinics assist in providing health services for the underserved and underinsured. Call
614-221-6494 or visit www.ohiofreeclinics.org to find one in your area.
Retirement benefits
If you lose your job, make sure you have a copy of your plan’s current summary plan
description (SPD) and your individual benefit statement. If not, request a copy. The SPD tells
you if and when you can collect your benefits or how to roll over your 401(k) account to a new
employer’s plan or to an IRA (if your old plan permits you to do so). The individual benefit
statement lets you monitor your account balance and is an important statement to keep on file.
Your retirement savings could also remain in your former employer’s plan. If your benefits
are in a traditional pension plan and your plan ends without enough money to pay the
promised benefits, the Pension Benefit Guaranty Corporation will assume responsibility as
trustee of the plan and pay benefits up to a maximum guaranteed amount set by law.
Tips:
• Talk with an insurance agent.
• Comparison shop, call around and ask questions. Premiums for similar products can
vary.
• If you are healthy, don’t assume you can go without insurance.
• If you’re without coverage: ask your doctor about a payment plan, don’t visit the doctor
for essential reasons, switch from brand name to generic prescription drugs and check
for free medication samples.
• Contact your physician, drug manufacturers and the State of Ohio to learn of
prescription drug patient assistance programs. Call 1-877-794-6446 for more
information.
• Contact the Ohio Department of Insurance at 1-800-686-1526 with any insurance
questions and to request informational materials.
• Contact the Ohio Department of Job and Family Services at 1-877-852-0010 if you are
unemployed and without coverage.
Governor John R. Kasich
www.ohioinsurance.gov
Lt. Governor/Director Mary Taylor